Is This the Big One?

We know that a pandemic is coming. We don’t know when and how. Something’s coming out of Mexico (though the index case might have been someplace else, too soon to tell). Is this the Big One, the pandemic that we are overdue for?

I am gathering information here to make sure I understand it, and how to protect myself and my family.

Avian influenza is influenza type A, subtype H5N1. The porcine influenza found in Mexico is type A, subtype H1N1. Influenza type B is much less dangerous, but is unfortunately not what we are dealing with here. The 1918 pandemic was type A, subtype H1N1 — the same that is circulating in Mexico today. Matching subtypes does not mean that there’s matching virulence, but it’s a clear danger sign.

There are two medecines of interest.

Zanamivir, trade name Relenza (no generics available). A neuraminidase inhibitor. Must be administered by inhaler. Some evidence it is more effective than tamiflu, but little work has been done, for some reason Tamiflu gets all the press.

Oseltamivir, trade name Tamiflu. An orally active neuraminidase inhibitor. It is maintained in huge stockpiles by governments as a hedge against avian flu. Cases are already being treated with it, there is no public info I saw on its effectivness. A friend told me according to info he saw (don’t know if it was public or not) the virus responds to Tamiflu.

Both drugs are effective against Type A and Type B.

Word on the street from Mexico is panicy and points to a long development of the situation and underestimation in public pronouncements. This is expected and normal. The quesiton is what to do about it? Later, there will be finger pointing (or none at all — China and WHO have avoided scrutinty of their massive underreporting of the true impact of SARS, likely 10x or more the official counts). Right now, people have to decide what to do with the early, partial, bad information. One of the courses of action is “nothing out of the ordinary”, which is by default what we are all doing. The fact that Mexico is in full emergency, the USA has just declared an emergency, and the WHO has declared this an event of international concern means it’s probably time to stop the ordinary.

My life is already blessedly empty of large gatherings of people (I’m a geek, we don’t do people). Each day I choose whether to go to the office or not, and maybe now I’ll start to prefer home, until I know more. Perhaps I’ll walk and use taxis instead of the bus, seems like a simple way to reduce exposure to sick people.

Tamiflu is only available in the UK with doctor’s orders, it seems. There are online pharmacies that ask you a bunch of questions, then send the questions to a doctor, who will supposedly “review” the answers, then release the drugs to you for sale. What a sleazy loophole, online pharmacies. I wonder who those doctors are, and how they sleep at night.

Finally, to put it in perspective a bit. The pandemic of 1918 had peak fatalities of less than 25% of each affected community. I can live with odds of 1 in 4, though it’s a bit grim. With modern medicine, the case fatality rate for this outbreak will undoubtedly be much lower, and the attack rate of the virus is likely to be either in the same range as 1918, or lower (why? there’s an upper bound to how virulent a virus can be; humans are not machines, we have huge differences in our biology, and getting sick requires all the biology works just right).

The real problem with pandemic is economic and travel disruption. I think it is likely that there will be some. It’s likely that travel restrictions will come into effect. Hopefully they will not prevent us from receiving our guests for our wedding. But if it happens, it happens. Sad, but the party will go on, at least inside of Switzerland.

Here’s a typical example of how governments cover up and downplay outbreaks (or just confuse themselves and end up lying on accident). On the front page of Pandemic.gov, the US pandemic stage is listed as 0. When you click on it, you find the definitions (very good information design, I might add). The definitions seem to indicate that the US should either be in phase 0, 1, or 4. But apparently US phase 4 requires WHO to get to phase 6. What’s strange is that the US phases do not take into consideration the possibility that the US could be part of the initial wave of countries as it seems to be. So pretty much life as usual… you prepare and then the plans all go out the window because nature does whatever she wants anyway. 🙂

Update: It was fun to educate myself, but now I’m going back to my regularly scheduled blissful ignorace. Looks to me like smart people are managing a large but not dangerous outbreak correctly, and there’s nothing for me to do but be happy that they are doing their job.